Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
J Med Econ. 2010;13(2):273-83. doi: 10.3111/13696998.2010.482909.
To assess the resource implications and budget impact of managing cow milk allergy (CMA) in the Netherlands from the perspective of the healthcare insurers.
A model was constructed depicting the management of CMA in the Netherlands using information obtained from interviews with youth healthcare doctors (n = 14), general practitioners (n = 6) and paediatricians (n = 11) with relevant clinical experience of managing CMA. The model was used to estimate the expected level of healthcare resource use and corresponding cost (at 2007/08 prices) attributable to managing 4,382 new CMA sufferers.
The expected cost of healthcare resource use attributable to managing 4,382 new CMA sufferers up to 1 year of age following initial consultation with a community-based physician at a mean 3 months of age was estimated to be €11.28 (95% CI: €7.82; €14.33) million. Clinical nutrition preparations emerged as the primary cost driver accounting for 91% of the total cost and clinician visits collectively accounted for a further 5%. The time taken for CMA sufferers to be put on an appropriate diet and achieve symptom resolution was estimated to be 30 (95% CI: 27; 32) days. Sensitivity analysis showed that the costs would increase by approximately 16% if all new CMA sufferers were to undergo a double-blind placebo-controlled cow milk challenge in a hospital setting, as is currently being proposed. It is not clear how this proposal would affect time to symptom resolution since this would depend on the efficiency of hospitals being able to deal with the increased workload.
The intolerance rates were derived from a 1-year follow-up study among 1,000 infants with CMA in the UK, healthcare resource use was not collected prospectively and the study period was censured at 1 year of age and does not consider the impact of CMA in subsequent years. However, most children outgrow this form of allergy during their second year.
Within the model's limitations, CMA imposes a substantial burden on the Dutch healthcare system. Moreover, initiating a double-blind placebo-controlled cow milk challenge for all CMA sufferers will potentially increase clinicians' workload and use of limited resources within paediatric hospital departments in the Netherlands.
从医疗保险公司的角度评估荷兰管理牛奶过敏（CMA）的资源影响和预算影响。
使用从具有管理 CMA 相关临床经验的青年保健医生（n=14）、全科医生（n=6）和儿科医生（n=11）访谈中获得的信息，构建了一个描述荷兰管理 CMA 的模型。该模型用于估计归因于管理 4382 名新 CMA 患者的预期医疗保健资源使用水平和相应成本（按 2007/08 年价格计算）。
在社区医生初次就诊后，预计 3 个月大的 4382 名新 CMA 患者在 1 年内的医疗保健资源使用总成本为 1128 万欧元（95%CI：782 万欧元；1433 万欧元）。临床营养制剂成为主要成本驱动因素，占总成本的 91%，临床医生就诊共占 5%。CMA 患者接受适当饮食和症状缓解的时间估计为 30 天（95%CI：27 天；32 天）。敏感性分析表明，如果所有新的 CMA 患者都要在医院环境中进行双盲安慰剂对照牛奶挑战，成本将增加约 16%，这是目前正在提议的。目前尚不清楚这一提议如何影响症状缓解时间，因为这将取决于医院处理增加工作量的效率。
不耐受率是从英国 1000 名 CMA 婴儿为期 1 年的随访研究中得出的，医疗保健资源的使用没有前瞻性收集，研究期限截止到 1 岁，并且不考虑 CMA 在随后几年的影响。然而，大多数儿童在第二年就会摆脱这种过敏。
在模型的局限性内，CMA 给荷兰医疗保健系统带来了巨大负担。此外，对所有 CMA 患者进行双盲安慰剂对照牛奶挑战可能会增加荷兰儿科医院部门临床医生的工作量和有限资源的使用。
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